Impact of COVID-19 on US and Canadian neurologists' therapeutic approach to multiple sclerosis: a survey of knowledge, attitudes, and practices
Impact of COVID-19 on US and Canadian neurologists' therapeutic approach to multiple sclerosis: a survey of knowledge, attitudes, and practices
复制标题
DOI：
10.1007/s00415-020-10045-9
复制
发表时间：
2020-07-07
影响因子：
6
通讯作者：
Vogel, Andre
中科院分区：
文献类型：
--
作者：
Mateen, Farrah J.;Rezaei, Shawheen;Vogel, Andre
目的报告SARS-CoV-2（COVID-19）爆发早期神经免疫学家对多发性硬化（MS）患者的认识和决策及其治疗情况。方法于2020年4月设计并在线分发给神经科医生。结果调查对象250人，总应答率21.8%。243例患者在前6个月内见过≥ 10例MS患者（平均197例患者），并进行了进一步分析（92%美国，8%加拿大;平均执业时间16年; 5%农村，17%小城市，38%大城市，40%高度城市化）。患者数量平均下降79%（每月53-11例）。23%的人知道患者由于害怕COVID-19而自行停止DMT，估计有43%的人是在不听从医生建议的情况下这样做的。65%的受访者报告由于COVID-19推迟> = 1剂DMT（49%），改变给药间隔（34%），改为家庭输液（20%），转换DMT（9%）和完全停止DMT（8%）。DMT的变化在高效治疗Alemtuzumab、克拉屈滨、ocrelizumab、利妥昔单抗和那他珠单抗中最常见。35%的人没有改变DMT处方。98%的人表示担心他们的患者感染COVID-19，78%的人表示同样程度的担心自己。> 50%的人认为高效DMT可以延长SARS-CoV-2的病毒脱落，B细胞疗法可能会阻止疫苗的保护作用。远程医疗的加速和实践模式的改变被认为是实践中的重大转变。报告的处方变化和实践中断，由于COVID-19可能是暂时的，但可能对MS护理产生持久影响。
Objective To report the understanding and decision-making of neuroimmunologists and their treatment of patients with multiple sclerosis (MS) during the early stages of the SARS-CoV-2 (COVID-19) outbreak. Methods A survey instrument was designed and distributed online to neurologists in April 2020. Results There were 250 respondents (response rate 21.8%). 243 saw > = 10 MS patients in the prior 6 months (average 197 patients) and were analyzed further (92% USA, 8% Canada; average practice duration 16 years; 5% rural, 17% small city, 38% large city, 40% highly urbanized). Patient volume dropped an average of 79% (53-11 per month). 23% were aware of patients self-discontinuing a DMT due to fear of COVID-19 with 43% estimated to be doing so against medical advice. 65% of respondents reported deferring > = 1 doses of a DMT (49%), changing the dosing interval (34%), changing to home infusions (20%), switching a DMT (9%), and discontinuing DMTs altogether (8%) as a result of COVID-19. Changes in DMTs were most common with the high-efficacy therapies alemtuzumab, cladribine, ocrelizumab, rituximab, and natalizumab. 35% made no changes to DMT prescribing. 98% expressed worry about their patients contracting COVID-19 and 78% expressed the same degree of worry about themselves. > 50% believed high-efficacy DMTs prolong viral shedding of SARS-CoV-2 and that B-cell therapies might prevent protective vaccine effects. Accelerated pace of telemedicine and practice model changes were identified as major shifts in practice. Conclusions Reported prescribing changes and practice disruptions due to COVID-19 may be temporary but could have a lasting influence on MS care.